Period from the onset of regular uterine contractions until expulsion of the placenta

Labor

Characteristics of labor

Toil, trouble, suffering, bodily exertion, painful

amnestic effect after given medications to relieve pain like Medazolam/ Dormicum

Twilight effect

Factors that affect labor

 Size of baby

 Size of pelvis

 Presentation

Relation of the fetal long axis to that of the mother

Fetal lie

Predisposing factors for transverse lie

Multiparity

Placenta previa

Hydramnios

Uterine anomalies

Which presentation?
Usual presentation
Head is flexed sharply so that the chin is in contact w/ the thorax
Occipital/ Posterior fontanel is presenting part on IE

Vertex or occiput presentation

Which presentation?
Uncommon
fetal neck may be sharply extended so that the occiput & back come in contact
Fully extended
Look for 2 malar eminences w/ the opening w/c will create a triangle
Palpate for the ischial tuberosity w/c will create a straight line

Face presentation

Which presentation?
partially flexed head
the anterior/large fontanel, or bregma, presenting
transient
can lead to dystocia if does not change to vertex or face presentation

Sinciput presentation

Which presentation?
partially extended
transient
can lead to dystocia if it does not change to vertex or face presentation

Brow presentation

Which presentation?
thighs flexed, legs extended over anterior surfaces of the body
Only one among the breech presentations that has room for vaginal delivery unless preterm
FETAL ATTITUDE: extended vertebral column

Which maneuver of Leopold's maneuver?
Palms are placed on either side of thematernal abdomen Gentle but deep pressure is exerted BACK: hard, convex & resistant Orientation of the fetus can bedetermined if back is directedanteriorly, transversely, or posteriorly FETAL EXTREMITIES: numerous small,irregular, mobile parts

2nd/Umbilical grip

Which maneuver of Leopold's maneuver?
Grasping w/ the thumb & fingers of onehand the lower portion of the maternalabdomen just above the symphysis pubis PRESENTING PART NOT ENGAGED:movable mass will be felt, usually the head PRESENTING PART ENGAGED: Indicative that the lower fetal pole is inthe pelvis If cephalic presentation, the shoulder isfelt as a relatively fixed, knob like part

3rd/Pawlik's grip

Which maneuver of Leopold's maneuver?
Examiner faces the mother’s feet Tips of 3 fingers of each hand exerts deeppressure in the direction of the axis of thepelvic inlet One hand descends further than theother In cephalic presentation, the part of thefetus that prevents the deep descent ofthe hand is the CEPHALICPROMINENCE FLEXION ATTITUDE: if cephalicprominence is felt on the same side ofthe fetal extremities

4th/Pelvic maneuver

Sagittal suture frequently is deflected either posteriorly toward the promontory or anteriorly toward the symphisis
Baby will have a harder time to navigate across pelvis